Internal Medicine

0521779407-15 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:43

1074 Obesity

■Severe restriction (<1000 kcal/day) not recommended

■Difficult compliance

■May reduce resting metabolic rate, promoting weight gain when

restriction stopped

VLCD

■Poor long-term weight loss maintenance

Pre-Packaged Meal Programs

■Must learn food preparation, sensible dining out, self-controlled

social eating for long-term maintenance

Fad Diets

■Weight loss from lower total calorie levels or diuresis, not diet com-

position

■No documentation of safety or long-term weight loss effectiveness

Physical Activity/Exercise

■Musculoskeletal complaints

■Requires individualized guidance

Behavior Modification

■No known side effects or complications

Pharmacotherapy

■Addiction/severe dehydration possible

■Long-term consequences unknown, i.e., fenfluramine and dexfen-

fluramine (primary pulmonary hypertension)

■Sibutramine (hypertension, bradycardia)

■Xenical (oily diarrhea, potential malabsorption of fat-soluable vita-

mins, carotenoids)

■Surgery

■Risk of death

■Potential vitamin B12, calcium, iron malabsorption, anemia

■Weight loss may not meet expectations, especially if high calorie

foods eaten

■Alternate weight loss products

■Ephedra (17 deaths)

■Caffeine (dehydration, irregular heart beat, no weight loss shown)

■Chitosan (vitamin E malabsorption, increased calcium excretion,

decreased bone density, no significant weight loss)

■Pyruvate (no physiologically relevant weight loss)